Objective To describe the survival status and to analyze the related factors of mortality among elderly patients with first-ever stroke.Methods Totally 1 96 elderly patients with first-ever stroke from January 2010 to January 2014 were enroll for the study.The survival status of all cases was attained through follow-up,and the deadline of follow-up was July 30,2014.The deceased patients because of stroke were divided into death group while the others were divided into survival group.Univariate com-parison and multivariate Logistic regression analysis were performed to screen out the related factors of death.Results The median follow-up time was 41 months,and 14 cases were lost to follow-up.The survival rate 28 d,1 year and 3 years after the onset were 73.47%,66.81% and 58.89%.Age,complication,Glasgow score,NIHSS score and blood WBC were the independent influence fac-tors of death (P <0.05).Conclusion The death among elderly patients with first-ever stroke are more concentrated in 28 d after the onset.Advanced age,complications,decrease of Glasgow score,increase of NIHSS score and blood WBC could increase the death risk.

Objective To investigate effect of combination of rosuvastatin and dual antiplatelet therapy on the serum CRP, cerebral vascular event recurrence rate and carotid artery plaque in cerebral infarction patients.Method 60 cerebral infarction patients were seleted and divided into the control group and the experiment group by different treatment(n=30).Two groups were treated by corresponding drugs.The serum levels of IMT, CRP, plaque area, plaque number and the cases of recurrent cerebral vascular events after 6 month were compared after treatment a month.Results Compared with the control group after treatment,the serum CRP were lower(P<0.05),the recurrence rate of cerebral vascular events were lower(P<0.05),the IMT value, patch area and the number of carotid plaques were lower(P<0.05).Conclusion Rosuvastatin and dual antiplatelet combination therapy has good clinical effect for cerebral infarction patients,and have the clinical guiding significance.

Objective To explore the cell-mediated immune function in patients with colon cancer undergoing minilaparotomy or laparoscopic assisted right hemicolectomy. Methods From January 2009 to August 2014, the colon cancer patients receiving right hemicolectomy were retrospectively analyzed. According to the operation mode, the patients were divided into minilaparotomy group and laparoscopic-assisted group. The clinical and pathological data was analyzed. Cell counts of total CD3, CD4, CD8, CD19 as well as NK cells in venous blood samples were compared between 1 day before surgery and postoperative days (POD) 1 and 5. Measurement data with normal distribution was compared using the t test or Q test. Count data was analyzed usingχ2 test or Fisher exact probability. Results There were 408 patients with colon cancer undergoing right hemicolectomy, 26 patients of whom were excluded. The remaining 382 patients were recruited in the research, which were divided into minilaparotomy group (182 cases) and laparoscopic-assisted group (200 cases). There was no significant difference in the age, gender, body mass index, TNM staging, histological type, blood loss, return of bowel function, tumor location, hospital stay and postoperative complications between the two groups (all P> 0.05). The operating time in minilaparotomy group [(131.53 ± 22.57) min] was shorter than that in laparoscopic-assisted group [(167.53 ± 22.04) min], and there was significant difference (t=15.76, P= 0.00). Compared with prior to surgery, cell numbers of CD3, CD4, CD8, CD19 and NK cells were lower on POD 1 and POD 5 (all P< 0.05), but there was no difference between minilaparotomy group and laparoscopic-assisted group (all P>0.05). Conclusion The minilaparotomy and laparoscopic-assisted right hemicolectomy have same effect on cellular immune function of patients with colon cancer.

[Objective]To determine the efficacy and characteristics of percutaneous vertebroplasty in treating patients with vertebral osteoporosis fractures combined with intraosseous cyst.[Method]Thirteen cases of vertebral osteoporosis fractures combined with intraosseous cyst were performed with percutaneous vertebroplasty.Bone cement containing appropriate proportion allograft bone powder were injected to vertebral body according to the sererity of osteoporosis and the size of intraosseous cyst.[Result]According to standard of World Health Organization about pain,complete pain relief was in 10,partial in 2,and slight in 1 patient.One case developed bone cement leakage into the paravertebral soft tissues during operation,but there were no clinical signs and symptoms.The next vertebral body fracture was found at sixteen days after percutaneous vertebroplasty in 1 case,and percutaneous vertebroplasty was repeated to relieve his pain.This patient was followed-up for 1 year,and no refracture was observed.[Conclusion]Vertebral osteoporosis fractures combined with intraosseous cyst is a special disease in elderly population.Percutaneous vertebroplasty is effective and it shouled be the first option for treatment of patients with vertebral osteoporosis fractures combined with intraosseous cyst.The complications could be reduced by local treatment combined with anti-osteoporosis drugs and correct rehabilitation.

Objective To explore the effect of collaborative nursing on the quality of life and nursing of stroke patients. Methods Toally 84 care-givers for 84 stroke patients hospitalized during February 2014 to March 2016 were chosen. In the control group(hospitalized from Feburary 2013 to Feburary 2014), traditional nursing was carried out, while in the research group(hospitalized from March 2014 to March 2016), the collaborative care intervention was done. The comparisons were done between the two groups in terms of quality of life and care ability by the GHQ-28 quality of life scale assessment, family caregiver task inventory (FCTI) before the intervention and 4 weeks after the intervention. Results Before the intervention, the two groups had no significant differences in life quality and care ability (all P > 0.05). After the intervention, the scores on symptoms, anxiety, depression, insomnia and social dysfunction were all significantly higher than those of the control group (all P<0.05). The scores on the care role, strain, assistance, personal emotion control, family assessment and community resources, and adjustment of life to meet the care needs were all significantly lower than those of the control group (all P<0.05). Conclusions The collaborative care is effective in improving the quality of life of stroke patients. It can improve the care ability of the caregiver.

OBJECTIVE To analyze the prevalence of pathogen infection and the drug sensitivity of pathogen after liver transplantation so as to provide the reference to the effective clinical prevention and control of pathogen infection and drug resistant strains.METHODS A retrospective survey in 155 patients who underwent 158 orthotopic liver transplantation was carried out.RESULTS The incidence of pathogen infection after liver transplantation was 25.9%,the major pathogens were coagulase-negative Staphylococcus,then Pseudomonas aeruginosa and Acinetobacter.CONCLUSIONS It is very important to prevent pathogen infection and use antibiotic reasonably.Selection of effective antibiotics referring to the etiologic data and resistance of pathogen can help to prevent the drug resistant strains.

Objective To compare the influence for intravenous dexmedetomidine and midazolam during combined spinal and epidural anesthesia (CSEA) on sedation,respiratory and circulatory.Methods Ninety patients with lower extremity fractures and internal fixation,were divided into dexmedetomidine group,midazolam group and control group by random digits table with 30 cases each.CSEA was performed at L3-4 interspace.After block reached T8 level,dexmedetomidine,midazolam and 0.9％ sodium chloride were given to the three groups.Ramsay score,mean arterial pressure (MAP),heart rate (HR),partial pressure of carbon dioxide in end expiratory gas (PErCO2),respiratory rate (RR) were recorded before anesthesia(T0),after CSEA (T1),and 10,15,30,45,60 min after giving drug (T2-T6),and intraoperative awareness was recorded.Results Ramsay score in dexmedetomidine group and midazolam group at T2-T6 were higher than those in the group T0,T1 and concurrent control group (P ＜ 0.05),MAP were lower than those in the group T0,T1 and concurrent control group (P ＜ 0.05).HR in dexmedetomidine group at T2-T6 were lower than those in concurrent midazolam group and control group (P ＜ 0.05).PETCO2 in midazolam group at T2-T6 were higher than those in concurrent dexmedetomidine group and control group (P ＜ 0.05),RR were lower than those in concurrent dexmedetomidine group and control group (P ＜ 0.05).The rate of intraoperative awareness in dexmedetomidine group and midazolam group was lower than that in control group [16.7％(5/30) and 13.3％(4/30) vs.93.3％(28/30),P＜0.05].Conclusions Dexmedetomidine and midazolam provide good sedation to reduce intraoperative awareness,slight inhibition of blood pressure.Dexmedetomidine can decrease HR,but it does not influence respiratory function.Midazolam restrains respiratory function.

Objective To identify risk factors for anastomotic leakage,and study the influence of high ligation of the inferior mesenteric artery on anastomotic leakage after rectal cancer resection.Methods The chi-test and the student t test were used for statistics.Clinical data were analyzed for 291 patients who underwent rectal cancer resection between August 2008 and November 2011.Results Anastomotic leakage occurred in 27 (9.3％) patients.Anastomotic leakage significantly increased in patients with tumours located within 10 cm from the anal verge,in male patients,and intraoperative blood loss.The use of high ligation of inferior mesenteric artery,which was associated with lower tumor location and surgical modality,was not a risk factor for anastomotic leakage,though it was associated with tumor stage and postoperative urinary retention.Conclusions Anastomotic leakage after rectal cancer resection is related to the tumor level,male gender,and perioperative bleeding,use of a high tie was not associated with an increased rate of symptomatic anastomotic leakage.

Objective To evaluate the diagnostic accuracy of the combination of endorectal ultrasonography and serum CEA in preoperative diagnosis of rectal wall invasion (T staging) and nodal involvement (N staging) of rectal carcinoma.Methods We retrospectively analyzed clinical records of 310 patients with rectal carcinoma who underwent endorectal ultrasonography and serum CEA evaluation in Shanxi Province Tumor hospital from January 2007 to January 2010.The positive standard of CEA is more than 5 μg/L.The endorectal ultrasonography staging with postoperative pathological staging,and calculated the overall accuracy of T staging and N staging based on TRUS alone or on TRUS combined with serum CEA level were compared.Results The difference in serum CEA level was statistically significant from T1 to T4 (P ＜ 0.05).The accuracy rate of preoperative T staging of rectal carcinoma by TRUS alone was 71％ (219/310) and was 82 ％ (254/310) with TRUS combined with serum CEA level,showing significant statistical difference (x2 =10.92,P ＜ 0.01).The accuracy rate of preoperative N staging of rectal carcinoma was 69 ％ (211/308)with TRUS alone and was 77 ％ (238/308) with TRUS combined with serum CEA level,the difference of which was statistically significant (x2 =5.00,P ＜ 0.05).Conclusion Serum CEA level increases with an increasing pathological stage of rectal cancer.The combination of TRUS and serum CEA improves the accuracy of preoperative staging of rectal cancer.

Objective To investigate the factors associated with postoperative complications after laparoscopic-assisted radical surgery in rectal cancer.Methods The clinical data of 310 patients with rectal cancer performed by laparoscopic-assisted radical resection from November 2010 to August 2013 were analyzed retrospectively.The differences between patients with and without postoperative complications were compared.All the data were analyzed by the t test,chi-square test or Logistic regression analysis.Results Among the 310 patients,postoperative complication occurred in 80 patients.On univariate analysis,postoperative complication was associate with gender,age,body mass index,preoperative comorbidity,diameter and location of tumor,TNM staging,operative time and surgeon experience (all P ＜ 0.05).Logistic regression analysis revealed that gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience were independent risk factors for postoperative complications (all P ＜ 0.05).Follow-up was available in 260 patients,with a median follow-up of 18 months (3-30 months).Differences in survival rates between patients with and without postoperative complications were no statistical significance (x2 =1.201,P =0.273).Conclusions Gender,body mass index,preoperative comorbidity,location of tumor,TNM staging and surgeon experience are independent risk factors for postoperative complications in laparoscopic-assisted radical surgery for rectal cancer.The short and medium-term survival time between patients with and without postoperative complications are similar.